Substance Use Disorders
DSM-II In DSM-II, this category is called Drug dependence This category is for patients who are addicted to or dependent on drugs other than alcohol, tobacco, and ordinary caffeine-containing beverages. Dependence on medically prescribed drugs is also excluded as long as the drug is medically indicated and the intake is proportionate to the medical need. The diagnosis requires evidence of habitual use or a clear sense of need for the drug. Withdrawal symptoms are not the only evidence of dependence; while always present when opium derivatives are withdrawn, they may be entirely absent when cocaine or marihuana are withdrawn. The diagnosis may stand alone or be couples with any other diagnosis. Disorders # Drug dependence, opium, opium alkaloids and their derivatives # Drug dependence, synthetic analgesics with morphine-like effects # Drug dependence, barbiturates # Drug dependence, other hypnotics and sedatives or "tranquilizers" # Drug dependence, cocaine # Drug dependence, Cannabis sativa (hashish, marihuana) # Drug dependence, other psycho-stimulants (amphetamines, etc.) # Drug dependence, hallucinogens # Other drug dependence DSM-III Disorders # Alcohol Abuse # Alcohol Dependence # Barbiturate or Similarly Acting Sedative or Hypnotic Abuse # Barbiturate or Similarly Acting Sedative or Hypnotic Dependence # Opioid Abuse # Opioid Dependence # Cocaine Abuse # Amphetamine or Similarly Acting Sympathomimetic Abuse # Amphetamine or Similarly Acting Sympathomimetic Dependence # Phencyclidine (PCP) or Similarly Acting Arylcyclohexylamine Abuse # Hallucinogen Abuse # Cannabis Abuse # Cannabis Dependence # Tobacco Dependence # Other, Mixed or Unspecified Substance Abuse # Other Specified or Unspecified Substance Dependence # Dependence on a Combination of Opioid and Other Nonalcoholic Substance # Dependence on a Combination of Substances, Excluding Opioids and Alcohol Differential Diagnosis Nonpathological substance use Nonpathological substance use for recreational or medical purposes is not associated with impairment in social or occupational functioning or a pathological pattern of use. Substance-induced intoxication Repeated episodes of substance-induced intoxication are almost invariably present in Substance Abuse or Dependence, although for some substances it is possible to develop dependence without ever exhibiting frank intoxication (e.g., alcohol). Furthermore, substance-induced intoxication as an isolated episode not involving either abuse or dependence is common. There are now methods to detect the presence of alcohol, barbiturates and similarly acting sedatives and hypnotics, opioids, cocaine, and amphetamines in serum or urine. In some cases the tests indicate that an individual who thinks he or she has been using one substance, such as cocaine, has in fact been taking something else, such as amphetamine crystals. A test dose may be used to establish tolerance to barbiturates by administering 200 mg of a short-acting barbiturate (usually pentobarbital) hourly until early signs of intoxication appear. The total amount of barbiturate required to produce these signs of intoxication is multiplied by a factor of three, giving an approximation of the individual's daily tolerance level to barbiturates. When Opioid Dependence is suspected, signs and symptoms of Opioid Withdrawal may be precipitated by the subcutaneous administration of 0.4 mg of naloxone, an opioid antagonist. (This should not be administered to individuals with a history of cardiac disease or coronary insufficiency.) DSM-IV Disorders # Substance Dependence # Substance Abuse DSM-5 See Substance-Related Disorders